The Cedars

The Cedars is a residential care home that provides accommodation and personal care for up to 28 older people. At the time of the inspection 17 people were living at the home.

The service is set over 2 levels, with communal areas such as a lounge and dining room on the ground floor.

People’s experience of using this service and what we found

Improvements had been made and were ongoing at the service. Actions in relation to fire safety had been completed. A plan was in place to continue upgrades to the environment. Changes to systems to monitor and assess the quality of the service had been made. However, further improvements were needed to ensure care planning information was person centred and accurate.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Improvements were required to ensure people’s consent and capacity was obtained and assessed in accordance with the Mental Capacity Act 2005.

People told us they were happy at the service. The service was fully staffed, and improvements had been made to recruitment processes. Staff were supported through induction, training and supervision.

Activity provisions continued to be developed and people were supported to engage in activities of their choice and access the local community.

People were supported by staff who were kind and caring. People were treated with dignity and respect. People’s independence was promoted.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 13 October 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulations 9 (Person Centred Care), 10 (Dignity and Respect), 12 (Safe Care and Treatment), 14 (Meeting Nutritional and Hydration Needs), 17 (Good Governance), 18 (Staffing) and 19 (Fit and Proper Persons Employed). The provider had met their recommendation in relation to the environment and had a plan of action in place to make further improvements.

This service has been in Special Measures since 22 August 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified a breach in relation to Regulation 11 (Need for consent).

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Cedars is a residential care home that provides accommodation and personal care for up to 28 older people. People who lived at the home access nursing care through the local community healthcare teams. At the time of the inspection 18 people were living at the home.

People’s experience of using this service and what we found

Since the last inspection of 7 and 8 June 2022 improvements had been made. However, the systems in place to monitor and audit the home needed to be fully embedded. The systems in place to capture all of the actions needed improvement. We spoke to the provider about implementing one action plan for the whole home. The provider had liaised with a consultancy company to help them make the required improvements from the last inspection.

At the last inspection, the provider had failed to identify or act to mitigate the risks to people. Improvements had been made to the information within people’s care records and risk assessments.

Some improvements had been made to the environment. Further improvements were needed to ensure this was maintained. The provider had liaised with contractors to have the bathroom suite fully replaced. A fire risk assessment remained outstanding. Some further improvements were required in relation to fire safety. An action plan was in place.

Safeguarding incidents had been reported by the provider to the local authority safeguarding team. The provider, trainee manager and staff had a good understanding of how to report safeguarding concerns. Improvements had been made to the home’s medicines system. We reviewed medicines records and found they had been completed effectively.

The homes occupancy was low at the time of the inspection. Staffing levels had been increased since the last inspection. The manager showed us a dependency tool which they used. Some further improvements were needed to the tool, to ensure it took into account the design of the building. We received feedback from staff and people that staffing levels were good at the home. Further improvements were needed to ensure staff were safely recruited. The provider was in the process of auditing staff files.

Since the last inspection statutory notifications had been appropriately reported to the Care Quality Commission. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

Rating at last inspection

This service was registered with us on 14 July 2021.

The last rating for the service was Inadequate, published on 23 August 2022, the service was in special measures. The service remains overall Inadequate.

Why we inspected

This inspection was prompted by intelligence, which we had received about the home since the last inspection in respect of people’s safety.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Cedars on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Cedars is a residential care home that provides accommodation and personal care for up to 28 older people. People who live at the home access nursing care through the local community healthcare teams. At the time of the inspection 20 people were living at the home.

People’s experience of using this service and what we found

There were widespread and systemic failings identified during the inspection. The quality and safety monitoring systems used by the provider were not fully effective in ensuring the quality of service provision and mitigate risks to people. This did not ensure people were treated with kindness, dignity and respect.

At the time of inspection there was no registered manager in place. There were also not enough suitably qualified staff to ensure people received safe and effective care. People did not receive adequate levels of personal care. Care was delivered in an institutional way.

Staff training was provided but was not always completed by staff before they started work. Training did not ensure people’s specific needs were covered. Staff recruitment procedures were not followed appropriately. Staff had not received regular supervision.

The provider had failed to make appropriate statutory notifications; notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled. Safeguarding incidents had not been identified and reported.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice.

Care plans did not contain sufficient information to ensure people received person centred care. The guidance within peoples' risk assessments were not always followed by staff and records used to monitor peoples' health were not always completed. This exposed people to risks unsafe or inappropriate care or treatment.

The provider had not provided people with person centred activities and access to the local community. The majority of people stayed in their rooms all day.

Procedures and records for the administration and the safety of medicines were not completed effectively.

The environment was not maintained effectively; there was an infection control risk to people using the service. Fire risk had not been appropriately managed.

People had access to healthcare professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 14 July 2021 and this is the first inspection.

The last rating for the service under the previous provider was Requires Improvement, published on 18 April 2020, the service was in special measures. The service has deteriorated to Inadequate.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Cedars on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to staffing, safeguarding, need for consent, recruitment, safe care and treatment, person-centred care, nutrition and hydration, dignity and respect, governance and notifications.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.